CRP elevated in patients with atopic dermatitis and sleep disorders: Study
USA: A recent study reported that adults with atopic dermatitis (AD) are at an increased risk of developing sleep disorders -- which is associated with higher levels of the inflammatory biomarker, C-reactive protein (CRP). This may substantially increase the risk of developing adverse cardiovascular outcomes and mortality. The findings of the study were presented during a late-breaking abstract session at the Revolutionizing Atopic Dermatitis virtual symposium.
Atopic dermatitis is an inflammatory skin disease common in both adults and children. It is associated with a significant reduction in quality of life and numerous systemic comorbidities. However, there is no clarity on the association between AD, sleep disturbance, and systemic inflammation. To fill this knowledge gap, Varsha Parthasarathy, Johns Hopkins Department of Dermatology, Baltimore MD, and colleagues aimed to examine the comorbidity burden of sleep disorders in AD patients and associate findings with inflammatory C-reactive protein and cardiovascular comorbidities in a large, multicenter cohort.
"The implications of these findings are vast," said presenting author Dr. Parthasarathy during the presentation. "Poor sleep quality is known to be associated with increased inflammatory markers such as IL-6, IL-17, and CRP, so it is interesting to see this reflected in AD patients with versus without sleep disturbance. Additionally, we know that CRP is a driver of inflammation and is strongly associated with cardiovascular complications such as heart attack and stroke. Therefore, CRP may be a useful prognostic marker in AD patients with sleep disturbances."
For carrying out the study, the researchers used TriNetX, a healthcare network of approximately 73 million medical records. AD patients aged 18 years or older were identified as having ≥2 instances of International Classification of Diseases, Tenth Revision (ICD-10) code L28 for AD, to identify a population with true atopic dermatitis.
These patients were age, race, and sex-matched to controls without AD presenting for general checkups. A total of 120,480 adult AD patients were identified.
To examine the possible impact of sleep disorders on inflammatory biomarkers, the researchers also examined C-reactive protein levels in these patients.
Key findings include:
- Before matching, the AD group was younger (36.4 ± 23.1 years vs. 46.8 ± 19.8 years) and had higher percentages of female sex (61% vs. 58%) and Black race (26% vs. 17%) than the controls.
- After matching, there were no age, gender, or racial differences between the groups.
- Relative to controls, AD patients had an increased risk of developing general sleep disorders [relative risk (RR) 1.10], obstructive sleep apnea [RR 1.13], insomnia [RR 1.10], hypersomnia [RR 1.24], sleep-related movement disorders [RR 1.36], restless legs syndrome [RR 1.25], sleep deprivation [RR 1.36], and unspecified sleep disorders [RR 1.22].
- AD patients had higher mean CRP than controls (mean ± SD 21.2 ± 43.9 mg/L vs. 7.6 ± 41.1 mg/L) and AD patients with sleep disorders had higher CRP than AD patients without sleep disorders (23.3 ± 44.3 mg/L vs. 20.6 ± 43.6 mg/L).
- AD patients with sleep disorders were more likely to develop obesity [RR 2.65], hyperlipidemia [RR 2.18], type 2 diabetes mellitus [RR 2.45], metabolic syndrome [RR 4.16], atherosclerosis [RR 2.42], peripheral vascular disease [RR 2.47], stroke [RR 2.37], venous thromboembolism [RR 2.93], and mortality [hazard ratio 1.24] than matched AD patients without sleep disorders.
"Adults with AD have an increased risk of developing sleep disorders, which is associated with elevation of the inflammatory biomarker, C-reactive protein," wrote the authors.
"This elevation in CRP may contribute to the systemic inflammatory impact of AD and substantially increase the risk of cardiovascular outcomes. Physicians are recommended to screen for these sleep-related comorbidities in all AD patients." they concluded.
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